Cerebrospinal fluid adenosine deaminase levels and adverse neurological outcome in pediatric tuberculous meningitis.
ABSTRACT There is a lack of data on the prognostic significance of changes in cerebrospinal fluid (CSF) parameters in tuberculous meningitis. Our objective was to determine whether changes in CSF parameters are associated with poor neurological outcome in tuberculous meningitis.
We conducted a prospective cohort study on children admitted with a diagnosis of tuberculous meningitis to Government General Hospital in Kakinada, India. On admission, CSF parameters including cell count with fraction of lymphocytes and neutrophil leukocytes, glucose, protein, lactic dehydrogenase (LDH), and adenosine deaminase (ADA) levels were measured. We compared levels in children with and without adverse neurological outcome.
A total of 26 children was enrolled over a 2-year period. Ten had an adverse neurological outcome. Six had permanent neurological deficits (four hemiplegia and two cranial nerve palsies), two a hydrocephalus and two died. There was no significant (p>0.05) difference in age, gender and in CSF parameters, including cell count, lymphocyte and neutrophil leukocyte fraction, glucose, protein, and LDH levels between patients with and without adverse neurological outcome. Patients with adverse outcome had with a mean (SD) of 17.1 (3.2) IU/l a significantly higher ADA level than patients without, who had a mean (SD) level of 11.3 (2.7) IU/l (p<0.001, t-test).
Adverse neurological outcome in childhood tuberculous meningitis is associated with increased cerebrospinal fluid adenosine deaminase levels.
- [Show abstract] [Hide abstract]
ABSTRACT: Objective We studied the possibility that the laboratory tests β-trace protein and cystatin C in cerebrospinal fluid could discriminate the existence or absence of a bacterial meningitis, compared to other tests such as glucose, protein, polymorphonuclear leukocytes count, neuron-specific enolase, adenosine deaminase and C-reactive protein, using Gram staining and bacterial cultures as reference techniques. Material and method We analyzed 73 cerebrospinal fluid samples, divided into 3 groups: control group, bacterial meningitis group, and a third group of other diseases with neurological repercussions, including viral meningitis. Results The control group was compared against the bacterial meningitis group and the group of diverse diseases, and the last 2 were both compared. Significant differences were observed between the bacterial meningitis group and the control group. Furthermore, a diagnosis algorithm was developed to differentiate bacterial meningitis from the other groups, based on the levels of glucose, β-trace protein, cystatin C and the polymorphonuclear leukocytes count. Conclusions Despite the small number of bacterial meningitis cases included, this study suggests that, β-trace protein and cystatin C could be good laboratory tests in order to discriminate a bacterial aetiology.Revista del Laboratorio Clínico. 03/2008; 1(1).
Article: Central nervous system tuberculosis.[Show abstract] [Hide abstract]
ABSTRACT: Central nervous system (CNS) involvement, one of the most devastating clinical manifestations of tuberculosis (TB) is noted in 5 to 10% of extrapulmonary TB cases, and accounts for approximately 1% of all TB cases. Definitive diagnosis of tuberculous meningitis (TBM) depends upon the detection of the tubercle bacilli in the CSF. Every patient with TBM should preferably be evaluated by imaging with contrast enhanced CT either before or within the first 48 hours of treatment. An extra-neural focus of tuberculosis should be sought clinically and radiologically in all patients with CNS TB as it may indicate safer and more accessible sites for diagnostic samplings. A minimum of 10 months treatment is warranted, prompted by the uncertain influences of disease severity, CNS drug penetration, undetected drug resistance and patient compliance. All patients with TB meningitis may receive adjunctive corticosteroids at presentation regardless of disease severity even for those with HIV infection. Drug resistance is strongly associated with previous treatment. The key principle of managing drug-resistant TB is never to add a single drug to a failing regimen. Early ventriculo-peritoneal shunting should be considered in those with hydrocephalus failing medical management. The single most important determinant of outcome is the stage of tuberculous meningitis at which treatment has been started.African health sciences 03/2011; 11(1):116-27.